MUHC/McGill researchers to WHO: Time to revise tuberculosis treatment guidelines

Montreal, 15 Sep 2009 - Tuberculosis is a global threat that affects more than 10 million people each year. Working with colleagues in the United States and France, Dr. Dick Menzies of the Research Institute of the McGill University Health Centre (RI-MUHC) has placed current tuberculosis treatment guidelines under the microscope in a new study. The team's conclusions, published today in two separate articles in the journal PLoS Medicine, recommend that the World Health Organization (WHO) must review and adjust its guidelines for fighting the disease.

"Our first study is a systematic review and meta-analysis of 57 studies, involving more than 20,000 patients from around the world," says Dr. Menzies. "It demonstrates that the treatment period should be extended for people affected by the active form of tuberculosis for the first time. Specifically, the study recommends that these patients should be treated with Rifampin for six months, instead of two months; the additional four months will help maximize the medication's effectiveness."

In the second article, the researchers assess guidelines for patients who have been treated but not cured. "Currently, these patients receive a cocktail of drugs over the course of eight months, which can result in drug resistance and a failure to cure in up to 45 per cent of cases," says Dr. Menzies. "More studies are needed to determine the optimal strategy. However, we believe that it is essential – indeed, of critical importance – to thoroughly review these guidelines."

"Our challenge as researchers is to put into place the most effective strategies for the treatment of tuberculosis, to determine the optimal length for courses of treatment so as to avoid relapse, and to formulate more effective combinations of drugs in order to avoid drug resistance," Dr. Menzies adds. The two studies will allow the WHO to review and update its directives for the treatment of tuberculosis, thereby benefiting the global community.

Dr. Dick Menzies is the Director of Respiratory Medicine at the MUHC and a researcher in the Respiratory Health Axis and Health Outcomes Axis at the Research Institute of the MUHC. He is also a Full Professor in the Departments of Medicine and Epidemiology, Biostatistics & Occupational Health in the Faculty of Medicine of McGill University.

Partners

This article was co-authored by Dr. Dick Menzies, Dr. Andrea Benedetti, Dr. Anita Paydar, Dr. Ian Martin and Dr. Madhukar Pai from the RI-MUHC, Dr. Sarah Royce from the University of California at San Francisco, San Francisco, USA, Dr. Andrew Vernon from the Centres for Disease Control and Prevention, Atlanta, USA Dr. Christian Lienhardt from the International Union against Tuberculosis and Lung Diseases and Institut de Recherche pour le Développement, Paris, France and Dr. William Burman, from the Denver Public Health, Denver, Colorado, USA

Funding

This study was funded by the World Health Organization (WHO). The Canadian Institutes of Health Research and the Fonds de la recherche en santé du Québec (FRSQ) provided salary support for some authors.